Method and apparatus for treating a bone fracture

ABSTRACT

Apparatus for treating a bone fracture, the apparatus comprising:
         an anchoring tube comprising a hollow elongated shaft adapted for disposition in a hole formed in a bone and having a distal end, a proximal end and a lumen extending therebetween, and a substantially planar plate mounted to the proximal end of the hollow elongated shaft and adapted for disposition against the outer surface of the bone;   wherein the plate comprises a top surface and a bottom surface, and further wherein the bottom surface of the plate is convex, such that when the anchoring tube is disposed in a hole formed in a bone and is rotated about the longitudinal axis of the hollow elongated shaft, the convex bottom surface of the plate maintains supporting contact with the outer surface of the bone.

REFERENCE TO PENDING PRIOR PATENT APPLICATIONS

This patent application claims benefit of:

(i) pending prior U.S. Provisional Patent Application Ser. No.61/596,056, filed Feb. 7, 2012 by Dennis McDevitt et al. for ANCHORINGPOST IMPLANT (Attorney's Docket No. MNR-1 PROV);

(ii) pending prior U.S. Provisional Patent Application Ser. No.61/669,852, filed Jul. 10, 2012 by Dennis McDevitt et al. for ANGLEDFIXATION POST (Attorney's Docket No. MNR-2 PROV);

(iii) pending prior U.S. Provisional Patent Application Ser. No.61/699,387, filed Sep. 11, 2012 by Dennis McDevitt et al. for FIXATIONPOST IMPLANT (Attorney's Docket No. MNR-3 PROV);

(iv) pending prior U.S. Provisional Patent Application Ser. No.61/699,715, filed Sep. 11, 2012 by Dennis McDevitt et al. for FIXATIONPOST IMPLANT (Attorney's Docket No. MNR-5 PROV); and

(v) pending prior U.S. Provisional Patent Application Ser. No.61/706,385, filed Sep. 27, 2012 by Dennis McDevitt et al. for SURGICALFASTENER (Attorney's Docket No. MNR-4 PROV).

The five (5) above-identified patent applications are herebyincorporated herein by reference.

FIELD OF THE INVENTION

This invention relates to surgical methods and apparatus in general, andmore particularly to surgical methods and apparatus for treating a bonefracture.

BACKGROUND OF THE INVENTION

It is common for bones to become fractured as the result of trauma,e.g., a fall, an automobile accident, a sporting injury, etc. Where abone has become fractured, it is frequently necessary to stabilize thebone in the area of the fracture so as to support the bone duringhealing. The ultimate goal of fracture treatment is to restore functionto the bone, and the key to restoring function to the bone is to ensureproper healing of the fracture site. The critical factors associatedwith proper healing of a fractured bone are (i) stable fixation of thefractured bone, and (ii) protection of the blood supply.

In general, a fracture fixation system is used to create a bridge acrossthe fracture site, and the fracture fixation system principally consistsof two components: (i) a bridging device (e.g., an internal fracturefixation plate, an intramedullary rod or nail, an external fracturefixation stabilizer, etc.), and (ii) bridge-to-bone interface elements(e.g., bone screws, pins, hooks, suture, wire, etc.). The location ofthe fracture, and the quality of the patient's bone, generally playmajor roles in determining the particular fracture fixation system whichis used to treat a fracture.

Treating fractures in the proximal humerus is particularly challengingdue to the anatomy of the proximal humerus and the surrounding tissue(e.g., soft tissue such as muscles, tendons and ligaments, neurovascularstructures, etc.). Recent innovations in proximal humeral fracturefixation have primarily focused on specific incremental advances in theart, e.g., improved thread designs for bone screws, improved designs forfracture fixation plates, locking mechanisms between fracture fixationplates and bone screws, improved drill guides for more accurateplacement of threaded pins, improved intramedullary nails and rods withvarying apertures for improved bone screw placement, etc. However, theserecent innovations in proximal humeral fracture fixation have notadequately addressed all of the clinical issues faced by the physician.

Significantly, the number of proximal humeral fractures occurring inosteopenic patients (particularly women) is growing. Treating proximalhumeral fractures in osteopenic patients is even more challenging thantreating proximal humeral fractures in non-osteopenic patients, due tothe poor bone quality common in osteopenic patients. Furthermore,increasing numbers of these fractures are being treated in ambulatorysurgical settings, which require the physician to treat the patientusing less invasive techniques. Current approaches for treating proximalhumeral fractures in osteopenic patients have proven inadequate,particularly where minimally invasive techniques must be used.

Thus there is a need for a new and improved method and apparatus fortreating bone fractures in general, and for treating proximal humeralfractures in particular.

SUMMARY OF THE INVENTION

The present invention provides a novel method and apparatus for treatingbone fractures in general, and for treating proximal humeral fracturesin particular.

In one form of the invention, there is provided apparatus for treating abone fracture, the apparatus comprising:

an anchoring tube comprising a hollow elongated shaft adapted fordisposition in a hole formed in a bone and having a distal end, aproximal end and a lumen extending therebetween, and a substantiallyplanar plate mounted to the proximal end of the hollow elongated shaftand adapted for disposition against the outer surface of the bone;

wherein the plate comprises a top surface and a bottom surface, andfurther wherein the bottom surface of the plate is convex, such thatwhen the anchoring tube is disposed in a hole formed in a bone and isrotated about the longitudinal axis of the hollow elongated shaft, theconvex bottom surface of the plate maintains supporting contact with theouter surface of the bone.

In another form of the invention, there is provided apparatus fortreating a bone fracture, the apparatus comprising:

an anchoring tube comprising a hollow elongated shaft adapted fordisposition in a hole formed in a bone and having a distal end, aproximal end and a lumen extending therebetween, and a substantiallyplanar plate mounted to the proximal end of the hollow elongated shaftand adapted for disposition against the outer surface of the bone;

wherein the hollow elongated shaft comprises at least twodiametrically-opposed holes extending therethrough; and

a suture assembly extending through a bone fragment, through at leastone of the diametrically-opposed holes in the hollow elongated shaft,and through the lumen of the anchoring tube, the suture assemblysecuring the bone fragment to the anchoring tube under tension, wherebyto secure the bone fragment to the bone receiving the anchoring tube.

In another form of the invention, there is provided apparatus fortreating a bone fracture, the apparatus comprising:

an anchoring tube comprising a hollow elongated shaft adapted fordisposition in a hole formed in a bone and having a distal end, aproximal end and a lumen extending therebetween, and a substantiallyplanar plate mounted to the proximal end of the hollow elongated shaftand adapted for disposition against the outer surface of the bone;

wherein the hollow elongated shaft comprises at least twodiametrically-opposed holes extending therethrough;

a breakaway rod for disposition within the lumen of the hollow elongatedshaft, the breakaway rod comprising a distal end, a proximal end, a holeproximal to the distal end for alignment with at least twodiametrically-opposed holes formed in the hollow elongated shaft, and abreakaway section proximal to the hole formed in the breakaway rod; and

a fixation element for extending through a bone fragment, through twodiametrically-opposed holes in the hollow elongated shaft, and throughthe hole in the breakaway rod for securing the bone fragment to theanchoring tube, whereby to secure the bone fragment to the bonereceiving the anchoring tube.

In another form of the invention, there is provided apparatus fortreating a bone fracture, the apparatus comprising:

a suture assembly comprising a suture and a buckle for mounting to thesuture, wherein the buckle comprises a plate having two holes formedtherein, a bridge extending between the two holes, and a slot connectingone of the two holes to a perimeter of the plate.

In another form of the invention, there is provided apparatus fortreating a bone fracture, the apparatus comprising:

a suture assembly comprising a suture and a buckle, the bucklecomprising means for attaching a closed end of the suture to the bucklewithout tying.

In another form of the invention, there is provided a buckle holder forholding a buckle while suture is secured to the buckle, wherein thebuckle has two holes therein and a slot connecting one of the holes toan end of the buckle, the buckle holder comprising a body having aproximal end, a distal end, a top surface and a bottom surface, a pairof holes extending from the top surface to the bottom surface, a buckleseat adjacent the distal end and extending proximally, and a verticalslot opening on the distal end and extending proximally, the verticalslot extending between the top surface and the bottom surface, thebuckle holder being sized so that the buckle seat can receive thebuckle, with the two holes in the buckle being aligned with the twoholes in the buckle holder.

In another form of the invention, there is provided a method fortreating a bone fracture, the method comprising:

providing an anchoring tube comprising a hollow elongated shaft adaptedfor disposition in a hole formed in a bone and having a distal end, aproximal end and a lumen extending therebetween, and a substantiallyplanar plate mounted to the proximal end of the hollow elongated shaftand adapted for disposition against the outer surface of the bone;

-   -   wherein the plate comprises a top surface and a bottom surface,        and further wherein the bottom surface of the plate is convex,        such that when the anchoring tube is disposed in a hole formed        in a bone and is rotated about the longitudinal axis of the        hollow elongated shaft, the convex bottom surface of the plate        maintains supporting contact with the outer surface of the bone;

forming a hole in the bone; positioning the hollow elongated shaft ofthe anchoring tube in the hole in the bone; and

rotating the anchoring tube about the longitudinal axis of the hollowelongated shaft while the convex bottom surface of the plate maintainssupporting contact with the outer surface of the bone.

In another form of the invention, there is provided a method fortreating a bone fracture, the method comprising:

providing apparatus comprising:

-   -   an anchoring tube comprising a hollow elongated shaft adapted        for disposition in a hole formed in a bone and having a distal        end, a proximal end and a lumen extending therebetween, and a        substantially planar plate mounted to the proximal end of the        hollow elongated shaft and adapted for disposition against the        outer surface of the bone;    -   wherein the hollow elongated shaft comprises at least two        diametrically-opposed holes extending therethrough; and    -   a suture assembly extending through a bone fragment, through at        least one of the diametrically-opposed holes in the hollow        elongated shaft, and through the lumen of the anchoring tube,        the suture assembly securing the bone fragment to the anchoring        tube under tension, whereby to secure the bone fragment to the        bone receiving the anchoring tube;

forming a hole in the bone;

positioning the hollow elongated shaft of the anchoring tube in the holein the bone; and

extending a suture assembly through a bone fragment, through at leastone of the diametrically-opposed holes in the hollow elongated shaft,and through the lumen of the anchoring tube, the suture assemblysecuring the bone fragment to the anchoring tube under tension, wherebyto secure the bone fragment to the bone receiving the anchoring tube.

In another form of the invention, there is provided a method fortreating a bone fracture, the method comprising:

providing apparatus comprising:

-   -   an anchoring tube comprising a hollow elongated shaft adapted        for disposition in a hole formed in a bone and having a distal        end, a proximal end and a lumen extending therebetween, and a        substantially planar plate mounted to the proximal end of the        hollow elongated shaft and adapted for disposition against the        outer surface of the bone;    -   wherein the hollow elongated shaft comprises at least two        diametrically-opposed holes extending therethrough;    -   a breakaway rod for disposition within the lumen of the hollow        elongated shaft, the breakaway rod comprising a distal end, a        proximal end, a hole proximal to the distal end for alignment        with at least two diametrically-opposed holes formed in the        hollow elongated shaft, and a breakaway section proximal to the        hole formed in the breakaway rod; and    -   a fixation element for extending through a bone fragment,        through two diametrically-opposed holes in the hollow elongated        shaft, and through the hole in the breakaway rod for securing        the bone fragment to the anchoring tube, whereby to secure the        bone fragment to the bone receiving the anchoring tube;

forming a hole in the bone;

positioning the breakaway rod within the lumen of the hollow elongatedshaft, and positioning the hollow elongated shaft of the anchoring tubein the hole in the bone; and

extending a fixation element through a bone fragment, through twodiametrically-opposed holes in the hollow elongated shaft, and throughthe hole in the breakaway rod, the fixation element securing the bonefragment to the anchoring tube, whereby to secure the bone fragment tothe bone receiving the anchoring tube.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other objects and features of the present invention will bemore fully disclosed or rendered obvious by the following detaileddescription of the preferred embodiments of the invention, which is tobe considered together with the accompanying drawings wherein likenumbers refer to like parts, and further wherein:

FIG. 1 is a schematic view showing fracture fixation in the proximalhumerus using novel fracture fixation apparatus formed in accordancewith the present invention;

FIGS. 2-7 are schematic views showing details of the anchoring tube ofthe novel fracture fixation apparatus shown in FIG. 1;

FIGS. 8 and 9 are schematic views showing details of the sutureassemblies of the novel fracture fixation apparatus shown in FIG. 1;

FIGS. 10-12 are schematic views showing a lateral entry drill guidewhich may be used in conjunction with the novel fracture fixationapparatus shown in FIG. 1;

FIGS. 13-15 are schematic views showing an inserter which may be used inconjunction with the novel fracture fixation apparatus shown in FIG. 1;

FIG. 16 is a schematic view showing a hoop guide which may be used inconjunction with the novel fracture fixation apparatus shown in FIG. 1;

FIGS. 17-19 are schematic views showing a crossbore aimer which may beused in conjunction with the novel fracture fixation apparatus shown inFIG. 1;

FIG. 20 is a schematic view showing a suture retriever which may be usedin conjunction with the novel fracture fixation apparatus shown in FIG.1;

FIGS. 21-43 are schematic views showing fracture fixation in theproximal humerus using the novel fracture fixation apparatus shown inFIG. 1;

FIG. 44 is a schematic view showing an alternative suture assemblybuckle formed in accordance with the present invention;

FIGS. 45-47 are schematic views showing a buckle holder which may beused in conjunction with the suture assembly buckle shown in FIG. 44;

FIGS. 48-56 are schematic views showing a suture being mounted to thesuture assembly buckle shown in FIG. 44 using the buckle holder shown inFIGS. 45-47;

FIG. 57 is a schematic view showing fracture fixation in the proximalhumerus using another novel fracture fixation apparatus formed inaccordance with the present invention;

FIG. 58 is a schematic view showing apparatus for use with the novelfracture fixation apparatus shown in FIG. 57;

FIGS. 59-66 are schematic views showing fracture fixation in theproximal humerus using the novel fracture fixation apparatus shown inFIG. 57;

FIG. 67 is a schematic view showing a variation of the fracture fixationapparatus shown in FIG. 57;

FIG. 68 is a schematic view showing fracture fixation in the proximalhumerus using still another novel fracture fixation apparatus formed inaccordance with the present invention;

FIGS. 69-73 are schematic views showing apparatus for use with the novelfracture fixation shown in FIG. 68; and

FIG. 74 is a schematic view showing fracture fixation in the proximalhumerus using yet another novel fracture fixation apparatus formed inaccordance with the present invention.

DETAILED DESCRIPTION OF THE INVENTION Fracture Fixation with SutureAssembly

Looking first at FIG. 1, there is shown novel fracture fixationapparatus 5 for treating bone fractures in general, and for treatingproximal humeral fractures in particular. As seen in FIG. 1, novelfracture fixation apparatus 5 generally comprises an anchoring tube 10for disposition in a proximal humerus 15, and one or more sutureassemblies 20 for securing bone fragments to anchoring tube 10 and, as aresult, for securing bone fragments to proximal humerus 15.

Anchoring tube 10 is shown in greater detail in FIGS. 2-7. Anchoringtube 10 generally comprises a hollow elongated shaft 25 having a distalend 30, a proximal end 35 and a lumen 40 extending therebetween, and agenerally planar plate 45 mounted to proximal end 35 of hollow elongatedshaft 25. In one form of the invention, plate 45 is formed integral withhollow elongated shaft 25. Plate 45 is mounted to proximal end 35 ofhollow elongated shaft 25 so that the plane of plate 45 extends at anangle of approximately 15-45 degrees, and preferably 25 degrees, to thelongitudinal axis of hollow elongated shaft 25. Hollow elongated shaft25 has a plurality of holes 50 extending transversely therethrough.Holes 50 are formed so that for every hole 50, there is a diametricallyopposing hole 50. Plate 45 has a substantially flat upper surface 55 anda convex lower surface 60. Plate 45 has a recess 65 formed in its uppersurface 55. Recess 65 communicates with interior lumen 40 of hollowelongated shaft 25. Plate 45 also has three holes 70, 75, 80 extendingtransversely therethrough. More particularly, holes 70 and 75 extendfrom upper surface 55 of plate 45 to lower surface 60 of plate 45. Hole80 extends from upper surface 55 of plate 45 to lumen 40 of hollowelongated shaft 25.

One of the suture assemblies 20 is shown in greater detail in FIGS. 8and 9. More particularly, each suture assembly 20 comprises a buckle 85and a suture 90. As seen in FIGS. 8 and 9, buckle 85 comprises anelongated body 95 having a first end 100 and a second end 105, and afirst hole 110 and a second hole 115. A bridge 120 is disposed betweenfirst hole 110 and second hole 115.

As seen in FIG. 1, anchoring tube 10 of fracture fixation apparatus 5 isintended to be disposed in proximal humerus 15, and the one or moresuture assemblies 20 of fracture fixation apparatus 5 are intended tosecure bone fragments to anchoring tube 10 and, as a result, to proximalhumerus 15. To this end, various instrumentation is provided in order toappropriately deploy fracture fixation apparatus 5 in proximal humerus15. More particularly, in one preferred form of the invention, thisinstrumentation comprises:

(i) a lateral entry drill guide 125 (FIGS. 10-12) for forming a hole inproximal humerus 15 for receiving anchoring tube 10;

(ii) an inserter 130 (FIGS. 13-15) for inserting anchoring tube 10 inthe hole formed in proximal humerus 15;

(iii) a hoop guide 135 (FIG. 16) for providing information about thedisposition of holes 50 in anchoring tube 10 when anchoring tube 10 isdisposed in proximal humerus 15;

(iv) a crossbore aimer 140 (FIGS. 17-19) for forming crossbores throughproximal humerus 15; and

(v) a suture retriever 145 (FIG. 20) for pulling suture throughanchoring tube 10.

Lateral entry drill guide 125 is shown in detail in FIGS. 10-12. Lateralentry drill guide 125 generally comprises a body 150 and a handle 155for manipulating body 150. Body 150 comprises a concave distal surface160, a proximal surface 165 and a surface 170 extending therebetween.Three holes 175, 180 and 185 extend from proximal surface 165 to distalsurface 160. A transverse hole 190 extends between surface 170 anddistal surface 160. Holes 175, 180 and 190 are positioned such thatholes 175 and 180 straddle, but do not intersect, hole 190. Holes 185and 190 are positioned such that hole 190 opens on distal surface 160 ofbody 150 laterally spaced from where hole 185 opens on distal surface160.

Inserter 130 is shown in detail in FIGS. 13-15. Inserter 130 generallycomprises an elongated shaft 195 having a distal end 200 and a proximalend 205. A mount 210 is formed at the distal end of elongated shaft 195.In one form of the invention, mount 210 is formed integral withelongated shaft 195. Mount 210 comprises a top surface 215 and asubstantially flat inclined surface 220 diametrically opposed to topsurface 215. A lumen 225 opens on inclined surface 220 of mount 210 andextends along the length of elongated shaft 195. Mount 210 comprises arecess 230 in its top surface 215. Recess 230 comprises a floor 235. Ahole 240 extends between top surface 215 and inclined surface 220. Twoholes 245, 250 extend from floor 235 of recess 230 to inclined surface220. A plurality of holes 255 are formed on the proximal end ofelongated shaft 195. Holes 255 are formed in a pattern which correspondsto the pattern of holes 50 formed on the distal end of hollow elongatedshaft 25 of anchoring tube 10, such that when anchoring tube 10 ismounted to inserter 130, holes 255 in elongated shaft 195 of inserter130 can be used to determine the disposition of holes 50 in hollowelongated shaft 25 of anchoring tube 10, as will hereinafter bediscussed in further detail.

Hoop guide 135 is shown in detail in FIG. 16. Hoop guide 135 generallycomprises an elongated body 260 having a distal end 265 and a proximalend 270. A hoop member 275 is connected to the distal end 265 ofelongated body 260. Hoop member 275 has a generally arcuateconfiguration sized to extend around the soft tissue surroundingproximal humerus 15, and comprises a plurality of holes 280 formedtherein. A mount 285 is connected to proximal end 270 of elongated body260. Mount 285 comprises a slot 290 formed therein.

Crossbore aimer 140 is shown in detail in FIGS. 17-19. Crossbore aimer140 comprises an outrigger 295 having a distal end 300 and a proximalend 305. Distal end 300 of outrigger 295 comprises a pair of parallelholes 310, 315 for receiving drill sleeves 320, 325 therein. Proximalend 305 of outrigger 295 comprises a hollow mount 330 having a lumen 335extending therethrough. Hollow mount 330 includes a transverse hole 340which communicates with lumen 335 of hollow mount 330. Transverse hole340 receives a set screw 345, such that set screw 345 can selectivelyintrude across lumen 335. Transverse hole 340 in hollow mount 330extends parallel to parallel holes 310, 315 formed in distal end 300 ofoutrigger 295.

Suture retriever 145 is shown in detail in FIG. 20. Suture retriever 145comprises an outer tube assembly 350 and an inner eyelet assembly 355.Outer tube assembly 350 comprises an elongated tube 360 having a distalend 365 and a proximal end 370, and a handle 375 secured to proximal end370 of elongated tube 360. A lumen 380 extends from distal end 365 ofelongated tube 360 to handle 375. A marking 385 is disposed on handle375. Inner eyelet assembly 355 comprises a shaft 390 having a distal end395 and a proximal end 400, a flexible loop 405 secured to distal end395 of shaft 390, and a handle 410 secured to proximal end 400 of shaft390. Flexible loop 405 preferably has a substantially planarconfiguration. A marking 415 is disposed on handle 410. Marking 415 onhandle 410 is set at a right angle to the plane of flexible loop 405,such that the orientation of flexible loop 405 may be determined byobserving the orientation of marking 415 on handle 410. Outer tubeassembly 350 and inner eyelet assembly 355 are sized such that shaft 390of inner eyelet assembly 355 may be slidably received within lumen 380of outer tube assembly 350. Furthermore, outer tube assembly 350 andinner eyelet assembly 355 are sized such that when shaft 390 of innereyelet assembly 355 is received within lumen 380 of outer tube assembly350, and when handle 410 of inner eyelet assembly 355 abuts handle 375of outer tube assembly 350, flexible loop 405 will protrude out of thedistal end of outer tube assembly 350.

Fracture fixation apparatus 5 may be used for treating bone fractures ingeneral, and for treating proximal humeral fractures in particular. Suchtreatment generally comprises:

(a) preparing a seat in proximal humerus 15 to receive anchoring tube10;

(b) positioning anchoring tube 10 in proximal humerus 15;

(c) preparing at least one crossbore in proximal humerus 15 to receivethe suture 90 of at least one suture assembly 20; and

(d) positioning the at least one suture assembly 20 so that its buckle85 bears against the outer surface of a bone fragment and its suture 90extends through the at least one crossbore and through anchoring tube10, whereby to secure the bone fragment to anchoring tube 10 and, as aresult, secure the bone fragment to proximal humerus 15.

(A) Preparing a Seat in Proximal Humerus 15 to Receive Anchoring Tube10.

1. As seen in FIG. 21, an insertion location is identified approximately10 cm below the lateral aspect of the acromion.

2. As seen in FIGS. 22-25, lateral entry drill guide 125 has its concavedistal surface 160 positioned against proximal humerus 15 at theinsertion location so that body 150 of lateral entry drill guide 125 isaligned with the humeral shaft while handle 155 is in line with theradius. This will cause hole 190 of lateral entry drill guide 125 to bedirected toward the humeral head with an inferior-lateral aspect. Withlateral entry drill guide 125 positioned in this manner, the lateralentry drill guide is secured to proximal humerus 15 using drilled guidepins 417 which extend through holes 175 and 180 of the lateral entrydrill guide and into proximal humerus 15.

3. A drill sleeve 420 is positioned in hole 190 of lateral entry drillguide 125. A set screw 422 is inserted through hole 185 in lateral entrydrill guide 125 so as to secure drill sleeve 420 in position relative tolateral entry drill guide 125. Then a guidewire 425 is drilled throughdrill sleeve 420, along the proximal humerus and up into the humeralhead.

4. Drill sleeve 420 is removed from hole 190, lateral entry drill guide125 is removed from proximal humerus 15, and a cannulated drill (notshown) is advanced over guidewire 425 and up into proximal humerus 15.

5. The cannulated drill and guidewire 425 are removed from proximalhumerus 15, leaving a hole 430 formed in the proximal humerus, as seenin FIG. 26. Note that this hole is offset from the intramedullary canalof proximal humerus 15 and opens on the inferior-lateral aspect of theproximal humerus.

At this point, an appropriate seat has been prepared in proximal humerus15 to receive anchoring tube 10.

(B) Positioning Anchoring Tube 10 in Proximal Humerus 15.

6. As seen in FIGS. 27-29, anchoring tube 10 is mounted to inserter 130,i.e., by positioning inclined surface 220 of inserter 130 against uppersurface 55 of anchoring tube 10, by passing a screw 435 through hole 240in inserter 130 and into hole 80 in anchoring tube 10, and by passing ascrew 440 through hole 250 in inserter 130 and into hole 170 inanchoring tube 10. As a result, anchoring tube 10 and inserter 130 maythereafter be manipulated as a single unit. It will be appreciated thatwhen anchoring tube 10 is so mounted to inserter 130, lumen 40 ofanchoring tube 10 communicates with, and is coaxial with, lumen 225 ofinserter 130. Furthermore, it will be appreciated that when anchoringtube 10 is so mounted to inserter 130, holes 255 of inserter 130correspond to holes 50 of anchoring tube 10, such that holes 255 ininserter 130 can be used to determine the disposition of holes 50 inanchoring tube 10.

7. Inserter 130 is used to advance anchoring tube 10 into hole 430formed in proximal humerus 15. Anchoring tube 10 is advanced intoproximal humerus 15 until convex lower surface 60 of plate 45 ofanchoring tube 10 seats against the outer surface of the proximalhumerus. Note that the plane of plate 45 of anchoring tube 10 will begenerally aligned with the outer surface of proximal humerus 15. Eitherbefore anchoring tube 10 is advanced into hole 430 in proximal humerus15, or after anchoring tube 10 has been advanced into hole 430 ofproximal humerus 15, hoop guide 135 is secured to inserter 130 so thathoop member 275 extends around the soft tissue surrounding proximalhumerus 15. See FIG. 30. Significantly, when hoop guide 135 is securedto inserter 130, holes 280 in hoop guide 135 are aligned with holes 50in anchoring tube 10. Thus, the disposition of holes 280 in hoop guide135 can be used to determine the disposition of holes 50 in anchoringtube 10. Preferably a drill guide 445 is interposed between inserter 130and hoop guide 135 when hoop guide 135 is mounted to inserter 130, witha hole 450 in drill guide 445 being aligned with hole 245 in inserter130 and with a hole 455 in drill guide 445 being aligned with hole 250in inserter 130.

8. Using holes 280 in hoop guide 135 as a visual guide, the physicianuses inserter 130 to rotate anchoring tube 10 as needed so as to ensurethat holes 280 in hoop guide 135, and hence holes 50 in anchoring tube10, are aligned with a bone fragment which is to be secured to theanchoring tube (and hence to proximal humerus 15). Significantly, convexlower surface 60 of plate 45 allows for at least 30 degrees of anchoringtube rotation, while still providing a stable footing for anchoring tube10 against proximal humerus 15, thereby allowing the physician toproperly align one or more of the holes 50 in anchoring tube 10 with abone fragment which is to be secured to the anchoring tube (and hence toproximal humerus 15).

9. After optimal positioning of anchoring tube 10 has been determined,hole 450 in drill guide 445 is used to form a hole in proximal humerus15, and then a screw 460 is used to secure anchoring tube 10 to proximalhumerus 15. See FIG. 31. Note that by forming hole 245 in inserter 130with a larger diameter than hole 75 in anchoring tube 10, screw 460 isable to pass through inserter 130 without directly coupling inserter 130to proximal humerus 15. Then hoop guide 135 and drill guide 445 may beremoved.

At this point, anchoring tube 10 has been appropriately positioned inproximal humerus 15. Note that anchoring tube 10 is set in proximalhumerus 15 in a position which is not aligned with the intramedullarycanal of the proximal humerus. It should be appreciated that bypositioning anchoring tube 10 in proximal humerus 15 in the foregoingmanner, deployment of the anchoring tube is achieved via a minimallyinvasive procedure, thereby minimizing trauma to the soft tissuesurrounding the proximal humerus. Moreover, by preserving the outerlayer of cortical bone, bone loss is minimized. In addition, blood lossduring the surgical procedure is also minimized. Finally, by positioninganchoring tube 10 in hole 430 formed in proximal humerus 15, rather thanin the intramedullary canal of the proximal humerus, the intramedullarycanal is preserved, thereby maintaining bone structure and function.

(C) Preparing at Least One Crossbore in Proximal Humerus 15 to Receivethe Suture 90 of at Least One Suture Assembly 20.

10. As seen in FIG. 32, crossbore aimer 140 is mounted on inserter 130,i.e., by fitting hollow mount 330 of crossbore aimer 140 over elongatedshaft 195 of inserter 130. A spacer 465 may be interposed between mount210 of inserter 130 and hollow mount 330 so as to properly positioncrossbore aimer 140 on inserter 130. Then crossbore aimer 140 is rotatedabout inserter 130 so that transverse hole 340 formed in hollow mount330 of crossbore aimer 140 is aligned with one of the holes 255 ininserter 130 (and, hence, parallel holes 310, 315 formed in distal end300 of outrigger 295 are aligned with one or more of the holes 50 inanchoring tube 10). Note that this alignment of holes 310, 315 incrossbore aimer 140 is reliably achieved even though holes 50 inanchoring tube 10 are hidden from sight within the interior of proximalhumerus 15. Then set screw 345 is advanced along transverse hole 340 incrossbore aimer 140 and into one of the holes 255 formed in inserter130, whereby to ensure that holes 310, 315 in crossbore aimer 140 arelocked in alignment with one or more of the holes 50 in anchoring tube10.

11. As seen in FIGS. 33 and 34, suture retriever 135 is advanced uplumen 225 of inserter 130 and lumen 40 of anchoring tube 10 so thatflexible loop 405 extends across the axes of holes 310, 315 of crossboreaimer 140 (and hence across the axis/axes of one or more of the holes 50in anchoring tube 10). Using markings 385, 415 of suture retriever 145,flexible loop 405 is turned as necessary so that the plane of flexibleloop 405 is set at a right angle to holes 310, 315 of crossbore aimer140.

12. As seen in FIG. 35, one or both of the drill sleeves 320, 325 arepositioned in holes 310, 315 of crossbore aimer 140, respectively.

13. A guidewire 470 is drilled through one of the drill sleeves 320, 325so as to pass through two diametrically-opposing holes 50 of anchoringtube 10, passing through flexible loop 405 of suture retriever 145 inthe process (FIG. 36).

14. A cannulated drill 475 is passed along guidewire 470 so that thecannulated drill passes through two diametrically-opposing holes 50 ofanchoring tube 10, and through flexible loop 405 of suture retriever 145(FIG. 37).

At this point, at least one crossbore has been formed in proximalhumerus 15 to receive the suture 90 of at least one suture assembly 20.

(D) Positioning the at Least One Suture Assembly 20 So that its Buckle85 Bears Against the Outer Surface of a Bone Fragment and its Suture 90Extends Through the at Least One Crossbore and Through Anchoring Tube10, Whereby to Secure the Bone Fragment to Anchoring Tube 10 and, as aResult, Secure the Bone Fragment to Proximal Humerus 15.

15. Guidewire 470 is removed from cannulated drill 475, and the two freeends of suture 90 of a suture assembly 20 are fed through the lumen ofcannulated drill 475, so that the two free ends of suture 90 passthrough two diametrically-opposing holes 50 of anchoring tube 10, andthrough flexible loop 405 of suture retriever 145 (FIG. 38). At thispoint, the closed loop 477 of suture 90 will reside outside cannulateddrill 475.

16. Cannulated drill 475 is removed from anchoring tube 10 as innereyelet assembly 355 is pulled proximally, thereby reducing the portionof flexible loop 405 extending out of elongated tube 360, whereby tocapture the two free ends of suture 90 of suture assembly 20 to thedistal end of suture retriever 145 (FIG. 39).

17. Suture retriever 145 is withdrawn from anchoring tube 10 andinserter 130 (FIG. 40), whereby to cause the two free ends of suture 90to extend through proximal humerus 15, down anchoring tube 10 and outinserter 130. The closed loop 477 of suture 90 will remain protrudingfrom the proximal end of a drill sleeve.

18. Drill sleeves 320, 325 are removed from crossbore aimer 140, andcrossbore aimer 140 is removed from inserter 130 (FIG. 41). Buckle 85can then be attached to the portion of closed loop 477 of suture 90which extends out of proximal humerus 15. This may be done by passingclosed loop 477 of suture 90 through first hole 110 of buckle 85. Afterpassing closed loop 477 through first hole 110 of buckle 85, closed loop477 is then passed over bridge 120 of buckle 85 and through second hole115 of buckle 85. Next, closed loop 477 is passed over second end 105 ofbuckle 85, so that one strand of closed loop 477 slides along each sideof buckle 85. Finally, closed loop 477 is passed over first end 100 ofbuckle 85, and the suture is pulled taut, thereby securing buckle 85 toclosed loop 477. See FIG. 41.

19. After buckle 85 has been mounted to suture 90, inserter 130 isremoved from anchoring tube 10 (alternatively, inserter 130 may beremoved from anchoring tube 10 before buckle 85 is mounted to suture90). Then the two free ends of suture 90 are pulled taut so as to pullbuckle 85 of the suture assembly against the outer surface of the bonefragment, and a screw 480 is passed through hole 70 in anchoring tube10, with screw 480 securing the two free ends of suture 90 to theanchoring tube under tension (FIG. 42). As a result of the foregoing,the tensioned suture assembly 20 will secure the bone fragment toanchoring tube 10 and, as a result, will secure the bone fragment toproximal humerus 15.

If desired, the foregoing procedure may be used to position multiplesuture assemblies 20 in proximal humerus 15 (FIG. 43), thereby providingthe opportunity to fix multiple bone fragments to proximal humerus 15.

Alternative Suture Assembly

If desired, a novel buckle 85A (FIG. 44) may be utilized, together witha novel buckle holder 485 (FIGS. 45-47).

Buckle 85A comprises an elongated body 95A having a first end 100A and asecond end 105A, and a first hole 110A and a second hole 115A. A bridge120A is disposed between first hole 110A and second hole 115A. A slot122A connects first hole 110A with first end 100A.

Novel buckle holder 485 comprises a shaft 490 having a distal end 495and proximal end 500. A horizontal slot 505 opens on distal end 495 andextends into buckle holder 485. Horizontal slot 505 (FIG. 45) is sizedso as to receive buckle 85A therein (FIG. 47). A first hole 510 and asecond hole 515 extend from one side of buckle holder 485 to the otherside of buckle holder 485, passing through slot 505. A vertical slot 520opens on distal end 495 and extends into buckle holder 485. Verticalslot 520 intersects both first hole 510 and second hole 515.

Looking now at FIGS. 47-56, buckle 85A may be loaded onto a suture 90(which has already been threaded through proximal humerus 15, anchoringtube 10 and inserter 130) in the following manner. First, buckle 85A isloaded into horizontal slot 505 of buckle holder 485 so that first hole110A of buckle 85A is aligned with first hole 510 of buckle holder 485,second hole 115A of buckle 85A is aligned with second hole 515 of buckleholder 485, and slot 122A of buckle 85A is aligned with vertical slot520 in buckle holder 485 (FIG. 47). Then the loop 525 emanating fromanchoring tube 10 and proximal humerus 15 is passed through second hole515 of buckle holder 485 and second hole 115A of buckle 85A (FIG. 48).Loop 525 is looped around the proximal end 500 of shaft 490 of buckleholder 485 (FIG. 49) and moved along the body of shaft 490 (FIG. 50) toa point distal to distal end 495 (FIGS. 51 and 52). The two free ends ofsuture 90 are then tensioned, drawing loop 525 along vertical bore 520and into second hole 515 of buckle holder 485 (FIGS. 53 and 54). At thispoint, suture 90 is wound around bridge 120A of buckle 85A. Then buckle85A may be pulled free from buckle holder 485 by pulling on the two freeends of suture 90, which slides buckle 85A out of horizontal slot 505 inbuckle holder 485 (FIGS. 55 and 56), thereby completing the task ofuniting buckle 85A and suture 90.

Fracture Fixation with Threaded Pins

Looking next at FIG. 57, there is shown novel fracture fixationapparatus 530 for treating bone fractures in general, and for treatingproximal humeral fractures in particular. As seen in FIG. 57, novelfracture fixation apparatus 530 generally comprises the aforementionedanchoring tube 10 for disposition in proximal humerus 15, and one ormore threaded pins 535 for securing bone fragments to anchoring tube 10and, as a result, for securing bone fragments to proximal humerus 15.Except as will otherwise be described below, novel fracture fixationapparatus 530 is identical to novel fracture fixation apparatus 5discussed above.

The primary differences between novel fracture fixation apparatus 530and novel fracture fixation apparatus 5 are (i) the substitution ofthreaded pins 535 in place of suture assemblies 20, and (ii) theprovision of a breakaway rod 540 (FIG. 58) for use in conjunction withthreaded pins 535. Breakaway rod 540 comprises a shaft 545 having adistal end 550 and a proximal end 555, at least one transverse hole 560extending through distal end 550, and a breakaway section 565 locatedproximal to the at least one transverse hole 560.

In use, novel fracture fixation apparatus 530 is used in a mannersimilar to novel fracture fixation apparatus 5, except that after theaforementioned step 10, when the apparatus is in the state shown inFIGS. 32 and 59, breakaway rod 540 is inserted up lumen 225 of inserter130 and into lumen 40 of anchoring tube 10 (FIG. 60). Proper sizing ofbreakaway rod 540, and an appropriate marking 570 on proximal end 555 ofbreakaway rod 540, permits the at least one transverse hole 560 inbreakaway rod 540 to be aligned with one or both of the holes 310, 315in crossbore aimer 140. Thereafter, using drill sleeves 320, 325, drill475 is advanced through proximal humerus 15, through twodiametrically-opposed holes 50 in anchoring tube 10 and through the atleast one transverse hole 560 in breakaway rod 540 (FIG. 61). Thencannulated drill 475, drill sleeves 320, 325 and crossbore aimer 140 areremoved (FIG. 62), leaving a bore 575 extending through proximal humerus15, two diametrically-opposed holes 50 in anchoring tube 10 and throughthe at least one transverse hole 560 in breakaway rod 540 (FIG. 62).Next, a threaded pin 535 is advanced through proximal humerus 15, twodiametrically-opposed holes 50 in anchoring tube 10 and through the atleast one transverse hole 560 in breakaway rod 540 (FIG. 63). At thispoint proximal end 555 of breakaway rod 540 is pulled proximally so asto cause breakaway rod 540 to separate at breakaway section 565 (FIG.64). The distal section of breakaway rod 540 remains in anchoring tube10, pierced by threaded pins 535, while the proximal section ofbreakaway rod 540 is removed. Then inserter 130 is removed, and screw480 is passed through hole 470 in anchoring tube 10 (FIG. 65). As aresult of the foregoing, threaded pin 535 will secure the bone fragmentto anchoring tube 10 and, as a result, to proximal humerus 15.

If desired, the foregoing procedure may be used to position multiplethreaded pins 535 in proximal humerus 15 (FIG. 66), thereby providingthe opportunity to fix multiple bone fragments to proximal humerus 15.

Fracture Fixation with Bone Screws

If desired, and looking now at FIG. 67, bone screws 580 may be used inplace of the aforementioned threaded pins 535. Preferably, bone screws580 are cannulated and delivered over a guidewire.

Fracture Fixation with Projecting Barbs

Looking next at FIG. 68, there is shown novel fracture fixationapparatus 585 for treating bone fractures in general, and for treatingproximal humeral fractures in particular. As seen in FIG. 68, novelfracture fixation apparatus 585 generally comprises the aforementionedanchoring tube 10 for disposition in a proximal humerus 15, and one ormore projecting barbs 590 for securing bone fragments to anchoring tube10 and, as a result, for securing bone fragments to proximal humerus 15.Except as will otherwise be described below, novel fracture fixationapparatus 585 is identical to novel fracture fixation apparatus 5discussed above.

The primary differences between novel fracture fixation apparatus 585and novel fracture fixation apparatus 5 are (i) the substitution ofprojecting barbs 590 in place of suture assemblies 20, and (ii) theprovision of a deployment mechanism 595 for deploying projecting barbs590 out of anchoring tube 10. More particularly, projecting barbs 590are secured to a mount 600, and deployment mechanism 595 comprises atube 605 and a plunger 610. As seen in FIGS. 69-71, mount 600 isreleasably carried by tube 605, with projecting barb 590 being disposedin tube 605 distal to plunger 610. Distal movement of plunger 601 withintube 605 causes projecting barbs 590 to advance distally and proximallyout of mount 600 and, at the limit of its throw, to separate mount 600from tube 605.

As a result of this construction, and looking now at FIGS. 68-73,deployment mechanism 595 can be used to carry mount 600 and projectingbarbs 590 into the anchoring tube 10, then cause projecting barbs 590 toadvance distally and proximally out of mount 600 and through holes 50 ofanchoring tube 10 and into adjacent bone and, at the limit of its throw,to separate mount 600 from tube 605. Mount 600 makes a friction fit withthe surrounding anchoring tube 10 to securely seat therein. As a resultof the foregoing, projecting barbs 590 are able to secure bone fragmentsto anchoring tube 10 and, as a result, to proximal humerus 15.

Fracture Fixation with Various Combinations of Suture Assemblies,Threaded Pins (or Bone Screws) and/or Projecting Barbs

It should be appreciated that anchoring tube 10 may be used with variouscombinations of suture assemblies 20, threaded pins 535 (or bone screws580) and/or projecting barbs 590, as preferred by the physician. Thus,for example, and looking now at FIG. 74, there is shown a fracturefixation utilizing a plurality of suture assemblies 20, threaded pins535 and projecting barbs 590.

Use of the Present Invention for Fracture Fixation in Applications Otherthan the Proximal Humerus

It should also be appreciated that the present invention may be used forfracture fixation in applications other than the proximal humerus. Byway of example but not limitation, the present invention may be used forfracture fixation in the femur.

MODIFICATIONS OF THE PREFERRED EMBODIMENTS

It should be understood that many additional changes in the details,materials, steps and arrangements of parts, which have been hereindescribed and illustrated in order to explain the nature of the presentinvention, may be made by those skilled in the art while still remainingwithin the principles and scope of the invention.

What is claimed is:
 1. Apparatus for treating a bone fracture, theapparatus comprising: an anchoring tube comprising a hollow elongatedshaft adapted for disposition in a hole formed in a bone and having adistal end, a proximal end and a lumen extending therebetween, and asubstantially planar plate mounted to the proximal end of the hollowelongated shaft and adapted for disposition against the outer surface ofthe bone; wherein the plate comprises a top surface and a bottomsurface, and further wherein the bottom surface of the plate is convex,such that when the anchoring tube is disposed in a hole formed in a boneand is rotated about the longitudinal axis of the hollow elongatedshaft, the convex bottom surface of the plate maintains supportingcontact with the outer surface of the bone.
 2. Apparatus according toclaim 1 wherein the hollow elongated shaft further comprises at leasttwo diametrically-opposed holes extending therethrough, and furtherwherein a fixation element extends through a bone fragment and at leastone of the two diametrically-opposed holes.
 3. Apparatus according toclaim 2 wherein the fixation element comprises a suture for securing thebone fragment to the anchoring tube under tension, whereby to secure thebone fragment to the bone receiving the anchoring tube.
 4. Apparatusaccording to claim 2 wherein the fixation element comprises a pin forsecuring the bone fragment to the anchoring tube, whereby to secure thebone fragment to the bone receiving the anchoring tube.
 5. Apparatusaccording to claim 4 wherein the pin is threaded.
 6. Apparatus accordingto claim 2 wherein the fixation element comprises a bone screw forsecuring the bone fragment to the anchoring tube, whereby to secure thebone fragment to the bone receiving the anchoring tube.
 7. Apparatus fortreating a bone fracture, the apparatus comprising: an anchoring tubecomprising a hollow elongated shaft adapted for disposition in a holeformed in a bone and having a distal end, a proximal end and a lumenextending therebetween, and a substantially planar plate mounted to theproximal end of the hollow elongated shaft and adapted for dispositionagainst the outer surface of the bone; wherein the hollow elongatedshaft comprises at least two diametrically-opposed holes extendingtherethrough; and a suture assembly extending through a bone fragment,through at least one of the diametrically-opposed holes in the hollowelongated shaft, and through the lumen of the anchoring tube, the sutureassembly securing the bone fragment to the anchoring tube under tension,whereby to secure the bone fragment to the bone receiving the anchoringtube.
 8. Apparatus according to claim 7 wherein a first portion of thesuture assembly bears against the bone fragment and a second portion ofthe suture assembly is secured to the anchoring tube.
 9. Apparatusaccording to claim 8 wherein the suture assembly comprises a bucklemounted to the first portion of the suture assembly, wherein the bucklebears against an outer surface of the bone fragment.
 10. Apparatusaccording to claim 9 wherein the buckle comprises a plate having atleast one hole formed therein.
 11. Apparatus according to claim 8wherein the second portion of the suture assembly is secured to theplate.
 12. Apparatus according to claim 11 wherein the second portion ofthe suture assembly is secured to the plate by a screw which alsosecures the plate to the bone.
 13. Apparatus according to claim 7wherein the plate comprises a top surface and a bottom surface, andfurther wherein the bottom surface of the plate is convex, such thatwhen the anchoring tube is disposed in a hole formed in a bone and isrotated about the longitudinal axis of the hollow elongated shaft, theconvex bottom surface of the plate maintains supporting contact with theouter surface of the bone.
 14. Apparatus according to claim 7 furthercomprising at least one pin extending through at least twodiametrically-opposed holes formed in the hollow elongated shaft. 15.Apparatus according to claim 14 wherein the pin is threaded. 16.Apparatus according to claim 7 further comprising at least one bonescrew extending through at least two diametrically-opposed holes formedin the hollow elongated shaft.
 17. Apparatus according to claim 7further comprising at least one barb extending through at least one holeformed in the hollow elongated shaft.
 18. Apparatus for treating a bonefracture, the apparatus comprising: an anchoring tube comprising ahollow elongated shaft adapted for disposition in a hole formed in abone and having a distal end, a proximal end and a lumen extendingtherebetween, and a substantially planar plate mounted to the proximalend of the hollow elongated shaft and adapted for disposition againstthe outer surface of the bone; wherein the hollow elongated shaftcomprises at least two diametrically-opposed holes extendingtherethrough; a breakaway rod for disposition within the lumen of thehollow elongated shaft, the breakaway rod comprising a distal end, aproximal end, a hole proximal to the distal end for alignment with atleast two diametrically-opposed holes formed in the hollow elongatedshaft, and a breakaway section proximal to the hole formed in thebreakaway rod; and a fixation element for extending through a bonefragment, through two diametrically-opposed holes in the hollowelongated shaft, and through the hole in the breakaway rod for securingthe bone fragment to the anchoring tube, whereby to secure the bonefragment to the bone receiving the anchoring tube.
 19. Apparatusaccording to claim 18 wherein the fixation element comprises a pin. 20.Apparatus according to claim 19 wherein the pin is threaded. 21.Apparatus according to claim 18 wherein the fixation element comprises abone screw.
 22. Apparatus according to claim 18 wherein the breakawayrod comprises a plurality of holes formed in the breakaway rod distal tothe breakaway section, and a plurality of fixation elements each forextending through a bone fragment, two diametrically-opposed holes inthe hollow elongated shaft, and a hole in the breakaway rod. 23.Apparatus according to claim 22 wherein the fixation elements areselected from the group consisting of a pin, a threaded pin and a bonescrew.
 24. Apparatus according to claim 18 further comprising a sutureassembly extending through a bone fragment, at least one of thediametrically-opposed holes, and the lumen of the anchoring tube, thesuture assembly securing the bone fragment to the anchoring tube undertension, whereby to secure the bone fragment to the bone receiving theanchoring tube.
 25. Apparatus according to claim 18 wherein the platecomprises a top surface and a bottom surface, and further wherein thebottom surface of the plate is convex, such that when the anchoring tubeis disposed in a hole formed in a bone and is rotated about thelongitudinal axis of the hollow elongated shaft, the convex bottomsurface of the plate maintains supporting contact with the outer surfaceof the bone.
 26. Apparatus for treating a bone fracture, the apparatuscomprising: a suture assembly comprising a suture and a buckle formounting to the suture, wherein the buckle comprises a plate having twoholes formed therein, a bridge extending between the two holes, and aslot connecting one of the two holes to a perimeter of the plate. 27.Apparatus according to claim 26 further comprising a buckle holder forholding the buckle while the suture is secured to the buckle, the buckleholder comprising a body having a proximal end, a distal end, a topsurface and a bottom surface, a pair of holes extending from the topsurface to the bottom surface, a buckle seat adjacent the distal end andextending proximally, and a vertical slot opening on the distal end andextending proximally, the vertical slot extending between the topsurface and the bottom surface, the buckle holder being sized so thatthe buckle seat can receive the buckle, with the two holes in the bucklebeing aligned with the two holes in the buckle holder.
 28. Apparatusaccording to claim 27 wherein the buckle seat comprises a recess openingon the distal end of the buckle holder and extending proximally. 29.Apparatus according to claim 28 wherein the recess comprises ahorizontal slot opening on the distal end of the buckle holder andextending proximally.
 30. Apparatus for treating a bone fracture, theapparatus comprising: a suture assembly comprising a suture and abuckle, the buckle comprising means for attaching a closed end of thesuture to the buckle without tying.
 31. A buckle holder for holding abuckle while suture is secured to the buckle, wherein the buckle has twoholes therein and a slot connecting one of the holes to an end of thebuckle, the buckle holder comprising a body having a proximal end, adistal end, a top surface and a bottom surface, a pair of holesextending from the top surface to the bottom surface, a buckle seatadjacent the distal end and extending proximally, and a vertical slotopening on the distal end and extending proximally, the vertical slotextending between the top surface and the bottom surface, the buckleholder being sized so that the buckle seat can receive the buckle, withthe two holes in the buckle being aligned with the two holes in thebuckle holder.
 32. Apparatus according to claim 31 wherein the buckleseat comprises a recess opening on the distal end of the buckle holderand extending proximally.
 33. Apparatus according to claim 32 whereinthe recess comprises a horizontal slot opening on the distal end of thebuckle holder and extending proximally.
 34. A method for treating a bonefracture, the method comprising: providing an anchoring tube comprisinga hollow elongated shaft adapted for disposition in a hole formed in abone and having a distal end, a proximal end and a lumen extendingtherebetween, and a substantially planar plate mounted to the proximalend of the hollow elongated shaft and adapted for disposition againstthe outer surface of the bone; wherein the plate comprises a top surfaceand a bottom surface, and further wherein the bottom surface of theplate is convex, such that when the anchoring tube is disposed in a holeformed in a bone and is rotated about the longitudinal axis of thehollow elongated shaft, the convex bottom surface of the plate maintainssupporting contact with the outer surface of the bone; forming a hole inthe bone; positioning the hollow elongated shaft of the anchoring tubein the hole in the bone; and rotating the anchoring tube about thelongitudinal axis of the hollow elongated shaft while the convex bottomsurface of the plate maintains supporting contact with the outer surfaceof the bone.
 35. A method according to claim 34 wherein the hollowelongated shaft further comprises at least two diametrically-opposedholes extending therethrough, and further wherein, after the anchoringtube has been rotated about the longitudinal axis of the hollowelongated shaft, extending a fixation element through a bone fragmentand at least one of the two diametrically-opposed holes.
 36. A methodaccording to claim 35 wherein the fixation element comprises a suturefor securing the bone fragment to the anchoring tube under tension,whereby to secure the bone fragment to the bone receiving the anchoringtube.
 37. A method according to claim 35 wherein the fixation elementcomprises a pin for securing the bone fragment to the anchoring tube,whereby to secure the bone fragment to the bone receiving the anchoringtube.
 38. A method according to claim 37 wherein the pin is threaded.39. A method according to claim 35 wherein the fixation elementcomprises a bone screw for securing the bone fragment to the anchoringtube, whereby to secure the bone fragment to the bone receiving theanchoring tube.
 40. A method for treating a bone fracture, the methodcomprising: providing apparatus comprising: an anchoring tube comprisinga hollow elongated shaft adapted for disposition in a hole formed in abone and having a distal end, a proximal end and a lumen extendingtherebetween, and a substantially planar plate mounted to the proximalend of the hollow elongated shaft and adapted for disposition againstthe outer surface of the bone; wherein the hollow elongated shaftcomprises at least two diametrically-opposed holes extendingtherethrough; and a suture assembly extending through a bone fragment,through at least one of the diametrically-opposed holes in the hollowelongated shaft, and through the lumen of the anchoring tube, the sutureassembly securing the bone fragment to the anchoring tube under tension,whereby to secure the bone fragment to the bone receiving the anchoringtube; forming a hole in the bone; positioning the hollow elongated shaftof the anchoring tube in the hole in the bone; and extending a sutureassembly through a bone fragment, through at least one of thediametrically-opposed holes in the hollow elongated shaft, and throughthe lumen of the anchoring tube, the suture assembly securing the bonefragment to the anchoring tube under tension, whereby to secure the bonefragment to the bone receiving the anchoring tube.
 41. A method fortreating a bone fracture, the method comprising: providing apparatuscomprising: an anchoring tube comprising a hollow elongated shaftadapted for disposition in a hole formed in a bone and having a distalend, a proximal end and a lumen extending therebetween, and asubstantially planar plate mounted to the proximal end of the hollowelongated shaft and adapted for disposition against the outer surface ofthe bone; wherein the hollow elongated shaft comprises at least twodiametrically-opposed holes extending therethrough; a breakaway rod fordisposition within the lumen of the hollow elongated shaft, thebreakaway rod comprising a distal end, a proximal end, a hole proximalto the distal end for alignment with at least two diametrically-opposedholes formed in the hollow elongated shaft, and a breakaway sectionproximal to the hole formed in the breakaway rod; and a fixation elementfor extending through a bone fragment, through two diametrically-opposedholes in the hollow elongated shaft, and through the hole in thebreakaway rod for securing the bone fragment to the anchoring tube,whereby to secure the bone fragment to the bone receiving the anchoringtube; forming a hole in the bone; positioning the breakaway rod withinthe lumen of the hollow elongated shaft, and positioning the hollowelongated shaft of the anchoring tube in the hole in the bone; andextending a fixation element through a bone fragment, through twodiametrically-opposed holes in the hollow elongated shaft, and throughthe hole in the breakaway rod, the fixation element securing the bonefragment to the anchoring tube, whereby to secure the bone fragment tothe bone receiving the anchoring tube.
 42. A method according to claim41 wherein the fixation element is a pin.
 43. A method according toclaim 42 wherein the pin is threaded.
 44. A method according to claim 41wherein the fixation element is a bone screw.